Rehabilitation Roadmap
6-Month Progressive Plan (Feb–Aug 2026)
Phase 1: Foundation
Weeks 1-4 (Feb 2026)
Stabilize nutrition, fix sleep, reduce bed time, baseline testing
Nutrition
Start creatine 5g/day in daily juice
Start whey protein 25g/day post-PT
Start lactoferrin 100mg/day
Start vitamin B6 50-100mg/day
Reduce fluid intake from 3L to 1.5-2L/day
Ensure ALL meals eaten while SEATED UPRIGHT
Separate baclofen from whey protein by 1-2 hours
Mobility
Current: 20 min wall standing daily
Add: 30 min seated in wheelchair x 4 times/day
Total upright time = 3-4 hours/day
Reduce bed time from 14+ hrs to 12 hrs
Sleep
Phase 1: Sleep 2AM → Wake 10AM
Phase 2: Sleep 1AM → Wake 9AM
Phase 3: Sleep 12AM → Wake 8AM
Phase 4 (target): Sleep 11PM → Wake 7AM
Add melatonin PR 2mg (if doctor approves)
NO naps between 7-9 PM
Morning light therapy: 30 min bright light upon waking
Medical
Weekly CBC with ANC
Ammonia level at 2 weeks
Complete pending blood tests (B12, folate, cortisol, ACTH, IGF-1)
Discuss quetiapine alternatives with neurologist
DEXA bone density scan
Phase 2: Building
Weeks 5-8 (Mar 2026)
Increase upright time, intensify PT, speech therapy, medication optimization
Nutrition
Assess ammonia - consider increasing to 30g WPI
Add Vitamin D3 2,000 IU + B Complex
Add Omega-3 ≤1,080mg/day
Mobility
Increase wheelchair sessions: 45 min x 4/day
Target: 5-6 hours upright/day
Introduce TheraBand resistance exercises
Speech
Request Melodic Intonation Therapy (MIT) assessment
Request LSVT LOUD assessment
Start communication boards
OT
Introduce SaeboStretch dynamic hand splint
Start hand exerciser and TheraPutty
Medical
Review ANC trend - decision on carbamazepine
Oncology follow-up for CEA 6.3
Phase 3: Intensification
Weeks 9-16 (Apr-May 2026)
Maximize PT, advance speech, neuromodulation, bladder program
Mobility
Target: 8-10 hours upright/day
Consider standing frame
FES if approved by neurologist
Speech
MIT: 3-4 sessions/week
LSVT LOUD: 16-session protocol
Bladder
Request urodynamic studies
Timed voiding schedule
Cognitive
Neuropsychological testing
Structured cognitive stimulation
Phase 4: Optimization
Weeks 17-24 (Jun-Aug 2026)
Consolidate gains, international rehab consideration, long-term planning
Assessment
Compile all progress data from Phases 1-3
Evaluate candidacy for intensive neurorehab
Medical
Medication simplification (fewer AEDs if seizure-free)
VPA should be fully tapered
Hearing aid evaluation
Updated ophthalmology assessment
Equipment
ROHO wheelchair cushion
Alternating pressure mattress (220V)
Tracking Metrics (Monthly)
| Metric | Baseline (Feb 2026) | Target |
|---|---|---|
| Hours in bed/day | 14+ hours | 8-10 hours |
| Hours upright/day | ~4-5 hours | 14-16 hours |
| Wall standing | 20 min | 30+ min |
| Creatinine | 0.57 mg/dL | 0.77-0.87 mg/dL |
| ANC | 0.7 x10³/μL | >1.5 x10³/μL |
| Magnesium | 1.7 mg/dL | >1.9 mg/dL |
| Weight | 85 kg | — |
| Sleep: bedtime | 2:00 AM | 11:00 PM |
| Sleep: wake time | 10:00 AM | 7:00 AM |
| Voice volume (1-5) | 1 | — |
| Behavioral outbursts/week | — | — |
| Height | 164 cm | — |
| BMI | 31.6 kg/m² | <30 kg/m² |
| Physio Sessions | 10 sessions | 10+ sessions |
| Occupational Therapy | 4 sessions | 4+ sessions |
| Dysphasia Therapy | 2 sessions | 3+ sessions |
| Protein Intake | 0 g/day | 80-95 g/day |
| Creatine Intake | 0 g/day | 5 g/day |